| NPI | 1730284134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D6484) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00006318) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2015-11-06 |