| NPI | 1366756728 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60292936) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DR 60168161) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2012-06-21 |