| NPI | 1356571756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60216300) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DR60093420) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2015-11-08 |