| NPI | 1376524132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 53529) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE 00005844) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2007-07-08 |