| NPI | 1447584545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60442634) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AR 3767) |
| Enumeration Date | 2009-09-23 |
| Last Update Date | 2015-02-11 |