| NPI | 1235676008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA DE60732747) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D10580) |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2024-09-19 |