NPI | 1194403808 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE61460133) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE61460133) |
Enumeration Date | 2023-07-11 |
Last Update Date | 2023-07-11 |