| NPI | 1114532934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE61095165) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 61095165) |
| Enumeration Date | 2020-09-09 |
| Last Update Date | 2025-06-24 |