| NPI | 1437321312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-4161) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00010582) |
| Enumeration Date | 2008-03-31 |
| Last Update Date | 2008-07-01 |