| NPI | 1972582880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00008876) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 12829) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2015-04-27 |