| NPI | 1538298567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 60035613) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR 9210) |
| 1223G0001X Dentist, General Practice (Licence: WI 5980) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2018-09-28 |