| NPI | 1982082343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: AZ D009463) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE.60554391) |
| Enumeration Date | 2015-05-18 |
| Last Update Date | 2016-06-07 |