| NPI | 1205560547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE61306840) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA DENT.DE.61306840) |
| Enumeration Date | 2022-07-12 |
| Last Update Date | 2022-08-05 |