| NPI | 1932410040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE 60178272) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D9437) |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2013-10-02 |