| NPI | 1932755691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: FL DN26709) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60967757) |
| Enumeration Date | 2019-08-16 |
| Last Update Date | 2022-05-09 |