| NPI | 1609852078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 22869) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 4697) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2009-02-20 |