| NPI | 1407976095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00010977) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D8648) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2010-04-06 |