NPI | 1326500109 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 122300000X Dentist (Licence: WA DE61067130) |
Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE61067130) |
390200000X Student in an Organized Health Care Education/Training Program | |
Enumeration Date | 2019-04-02 |
Last Update Date | 2020-12-09 |