| NPI | 1841578762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE60743293) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 61035) |
| 1223P0300X Dentist, Periodontics (Licence: AK 124752) | |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2018-09-30 |