| NPI | 1154297794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61628388) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61628388) |
| Enumeration Date | 2025-10-13 |
| Last Update Date | 2025-12-23 |