| NPI | 1922154749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE3732) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: WA AC189) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2007-07-08 |