| NPI | 1821438425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60465783) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9879) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2015-11-24 |