| NPI | 1992862593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00010588) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 5226914-9921) |
| 1223G0001X Dentist, General Practice (Licence: AZ 5775) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2012-08-30 |