| NPI | 1235861410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: OR D11768) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA DE61299108) |
| Enumeration Date | 2022-06-27 |
| Last Update Date | 2023-04-12 |