| NPI | 1326057134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: TX 21824) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00009437) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2023-03-17 |