| NPI | 1851876478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401418368) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D11398) |
| 122300000X Dentist (Licence: WA DE60882838) | |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2023-10-20 |