| NPI | 1114067204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00009505) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D7484) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2020-12-02 |