| NPI | 1922051093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60034731) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401008092) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2008-11-07 |