| NPI | 1043317449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 9791) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 4539) |
| 1223G0001X Dentist, General Practice (Licence: WA 7107) | |
| 124Q00000X Dental Hygienist (Licence: WA 5419) | |
| 124Q00000X Dental Hygienist (Licence: WA 5766) | |
| 124Q00000X Dental Hygienist (Licence: WA 7057) | |
| 124Q00000X Dental Hygienist (Licence: WA 6008) | |
| 124Q00000X Dental Hygienist (Licence: WA 2969) | |
| 124Q00000X Dental Hygienist (Licence: WA 4236) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |