| NPI | 1275606303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WA DE00010521) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DEN00010521) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2025-06-04 |