| NPI | 1962558106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 5366921-9922) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60083262) |
| Enumeration Date | 2007-01-27 |
| Last Update Date | 2011-04-06 |