| NPI | 1912983800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: AK 1117) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID 1926-D) |
| 122300000X Dentist (Licence: WA 6690) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2013-02-14 |