| NPI | 1932537875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60409006) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 62794) |
| Enumeration Date | 2013-10-30 |
| Last Update Date | 2024-11-18 |