| NPI | 1760822373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60468640) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SD 434) |
| 1223G0001X Dentist, General Practice (Licence: SD D1031) | |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2014-06-24 |