| NPI | 1184199267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60901870) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DENT.DE.60901870) |
| Enumeration Date | 2018-10-04 |
| Last Update Date | 2019-04-29 |