| NPI | 1730280918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D5838) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE 60121517) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2015-04-30 |