| NPI | 1215240452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NC 10368) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60164484) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2020-04-06 |