| NPI | 1568669554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE 00010894) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D4064) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2011-12-22 |