| NPI | 1033230636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60316987) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GU D1005) |
| 1223G0001X Dentist, General Practice (Licence: CA 52764) | |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2013-04-26 |