| NPI | 1922257542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: NV 3519) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 7266) |
| Enumeration Date | 2008-09-18 |
| Last Update Date | 2008-09-18 |