| NPI | 1386857894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE6045396) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D3687) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2015-07-15 |