| NPI | 1003282997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 41794) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60580376) |
| Enumeration Date | 2015-08-14 |
| Last Update Date | 2025-10-01 |