| NPI | 1831267491 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WA DE000007348) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA D22410) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2013-10-18 |