| NPI | 1972669828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE8932) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 20923) |
| 122300000X Dentist (Licence: ID D3608) | |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2015-06-05 |