| NPI | 1518140078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00007254) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 50860) |
| 122300000X Dentist (Licence: OR D9396) | |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2011-06-27 |