| NPI | 1922059906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 7629) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 4741-015) |
| 1223G0001X Dentist, General Practice (Licence: CO 9307) | |
| 1223G0001X Dentist, General Practice (Licence: TX 20800) | |
| 1223G0001X Dentist, General Practice (Licence: WA 61216943) | |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2024-11-01 |