| NPI | 1235427493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: FL DN19397) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60228655) |
| Enumeration Date | 2011-07-21 |
| Last Update Date | 2014-11-06 |