| NPI | 1184787178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE00010825) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 71414) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2009-10-20 |