| NPI | 1942450838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60028780) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA DDS57158) |
| Enumeration Date | 2008-09-26 |
| Last Update Date | 2011-07-22 |