| NPI | 1912395096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D10181) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60469990) |
| Enumeration Date | 2014-12-25 |
| Last Update Date | 2015-04-21 |