| NPI | 1508093386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60269425) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KS 60758) |
| Enumeration Date | 2009-06-18 |
| Last Update Date | 2012-05-22 |