| NPI | 1073683074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 9434) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00009434) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2012-10-09 |