| NPI | 1891926879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60309049) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D9322) |
| Enumeration Date | 2009-08-07 |
| Last Update Date | 2012-11-29 |