| NPI | 1477864643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: GA DN015192) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE-60185606) |
| 1223G0001X Dentist, General Practice (Licence: WA 60185606) | |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2016-07-26 |