| NPI | 1518354919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60656485) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D10216) |
| Enumeration Date | 2015-04-23 |
| Last Update Date | 2016-06-08 |