| NPI | 1871567016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60192688) |
| Additional Taxonomies | 122300000X Dentist (Licence: OH 30022014) |
| 122300000X Dentist (Licence: FL DN00000) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2015-11-12 |