| NPI | 1184139933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61046855) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN D13932) |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2024-04-10 |