| NPI | 1548474869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00010829) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401411897) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2008-06-23 |