NPI | 1558673806 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60174659) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DR60171701) |
Enumeration Date | 2010-07-01 |
Last Update Date | 2012-01-26 |