| NPI | 1972615938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D5207) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00007177) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2007-07-08 |