| NPI | 1386839397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 5151) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 8192) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2007-09-12 |