| NPI | 1154330728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OK 6369) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00009714) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2012-09-07 |