| NPI | 1003108820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60291946) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MT 2458) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2013-04-23 |