| NPI | 1235297706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00007957) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 7957) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2024-01-11 |