| NPI | 1861442071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60857601) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 11061) |
| 1223G0001X Dentist, General Practice (Licence: NC 6597) | |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2024-07-12 |