| NPI | 1386741239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X2210X Dentist Orofacial Pain (Licence: WA 10135) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA 10135) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-03-16 |