| NPI | 1538238779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE00004645) |
| Additional Taxonomies | 126800000X Dental Assistant (Licence: WA DE00008483) |
| 126800000X Dental Assistant (Licence: WA DE00010578) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2007-07-09 |