| NPI | 1295168938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D10338) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA DE60402384) |
| Enumeration Date | 2013-08-16 |
| Last Update Date | 2015-10-14 |