| NPI | 1891835112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122400000X Denturist (Licence: OR DTDO838758) |
| Additional Taxonomies | 122400000X Denturist (Licence: WA DN 00000379) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2010-06-29 |