| NPI | 1588684211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 6411) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D6386) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2007-07-08 |