| NPI | 1487981478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60262496) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D9369) |
| Enumeration Date | 2009-11-11 |
| Last Update Date | 2012-04-25 |