| NPI | 1265403281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE00010210) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D8862) |
| Enumeration Date | 2006-01-28 |
| Last Update Date | 2016-07-23 |