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 |