| NPI | 1821102229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WA 8233) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: OR 7233) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2007-07-08 |