| NPI | 1487866836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00010887) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NV 3470) |
| Enumeration Date | 2007-05-05 |
| Last Update Date | 2018-03-17 |