| NPI | 1841555950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NC 9289) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE 60281332) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2016-03-03 |