| NPI | 1346334950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE6814) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 34253) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2007-07-08 |