| NPI | 1477076727 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60876885) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D10817) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2018-09-14 |