| NPI | 1104988146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE 00007383) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 7383) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2011-07-08 |