| NPI | 1881941094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D9491) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE 60172663) |
| Enumeration Date | 2012-08-07 |
| Last Update Date | 2016-03-30 |