| NPI | 1174613566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00009895) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 57009) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2008-11-26 |