| NPI | 1417681198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61478519) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ D011502) |
| Enumeration Date | 2022-07-10 |
| Last Update Date | 2023-10-16 |