| NPI | 1376827543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60578282) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CT 010814) |
| Enumeration Date | 2011-10-05 |
| Last Update Date | 2021-06-22 |