| NPI | 1912156936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60093162) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DR60024923) |
| Enumeration Date | 2008-09-15 |
| Last Update Date | 2010-12-10 |