| NPI | 1841519998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE60260840) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NY 055744) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2024-04-04 |