| NPI | 1013026012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 0006055WA) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 0006055) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2011-02-25 |