| NPI | 1427789221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE70008198) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 7863) |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2025-12-09 |