| NPI | 1346317948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: OR D8855) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA DE00011144) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2015-08-24 |