| NPI | 1871683359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA 025103DE00007948) |
| Additional Taxonomies | 124Q00000X Dental Hygienist (Licence: WA DH00001904) |
| 126800000X Dental Assistant | |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2007-07-09 |