| NPI | 1861421471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00005337) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D5535) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2007-07-08 |