| NPI | 1942468004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60114393) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 56367) |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2016-06-14 |