| NPI | 1932123460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR 5305) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 139810-9922) |
| 1223G0001X Dentist, General Practice (Licence: WA DE00004952) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |