| NPI | 1053437731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D9919) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: FL DN14635) |
| 1223G0001X Dentist, General Practice (Licence: WA DE60390336) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2013-10-15 |