| NPI | 1124000526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00008757) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WV 2281) |
| 1223G0001X Dentist, General Practice (Licence: PA DS0254226) | |
| 1223G0001X Dentist, General Practice (Licence: OH 30-01-6653) | |
| Enumeration Date | 2005-11-19 |
| Last Update Date | 2007-07-08 |