| NPI | 1891257747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D11061) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61077121) |
| 122300000X Dentist (Licence: OR D11061) | |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2024-02-06 |