| NPI | 1396501987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE.70068709) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NC 14146) |
| Enumeration Date | 2024-02-22 |
| Last Update Date | 2026-06-29 |