| NPI | 1952734659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D10017) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60397210) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2014-08-12 |