| NPI | 1740307214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 59447) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA DE00010449) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2017-08-25 |