| NPI | 1487775912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60518208) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 25339) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2017-10-04 |