| 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 |