| NPI | 1245581016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60745689) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TN 10192) |
| 1223G0001X Dentist, General Practice (Licence: CA 61570) | |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2018-03-17 |