| NPI | 1750512927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 60098984) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60098984) |
| Enumeration Date | 2009-08-05 |
| Last Update Date | 2018-08-20 |