| NPI | 1508995176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00010835) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WA DE00010835) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2009-06-19 |