| NPI | 1407872237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: WA CP60058536) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 4323) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2009-08-19 |