| NPI | 1609033075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CO 9982) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00011186) |
| Enumeration Date | 2008-05-21 |
| Last Update Date | 2010-05-30 |