| NPI | 1194834895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00009252) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D7791) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2021-09-01 |