| NPI | 1104414002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: WA DE61124632) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61124632) |
| Enumeration Date | 2021-01-06 |
| Last Update Date | 2025-03-28 |