| NPI | 1053330308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 5460) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2025-01-01 |