| NPI | 1366636920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA DE60016999) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: CA 45114) |
| Enumeration Date | 2007-08-28 |
| Last Update Date | 2011-02-25 |