| NPI | 1134485154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WI 6883-15) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60595962) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2016-06-01 |