| NPI | 1043797178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60857581) |
| Additional Taxonomies | 125Q00000X Oral Medicine (Licence: WA DE60857581) |
| Enumeration Date | 2018-07-21 |
| Last Update Date | 2026-03-03 |