| NPI | 1689746711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WA DE00010028) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WA 10028) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2016-05-18 |