| NPI | 1669510939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: LA 5268) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE0009188) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2019-03-25 |