| NPI | 1811052277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D4363) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 7031) |
| 122300000X Dentist (Licence: ID D3346) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2007-07-08 |