| NPI | 1083925663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60332158) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60332158) |
| Enumeration Date | 2010-06-29 |
| Last Update Date | 2024-08-15 |