| NPI | 1255523700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 60146968) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-4083) |
| Enumeration Date | 2007-08-17 |
| Last Update Date | 2025-03-04 |