| NPI | 1437445103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 61351) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DR60225674) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2012-10-05 |