| NPI | 1437132305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00010199) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D8421) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2008-07-18 |