| NPI | 1841481702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: DC DEN1000655) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA DE60222405) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2011-07-29 |