NPI | 1285675652 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE5767) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D6001) |
Enumeration Date | 2006-06-09 |
Last Update Date | 2023-06-21 |