| NPI | 1437610516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: NM DD5207) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61402673) |
| 1223G0001X Dentist, General Practice (Licence: WA DE61402673) | |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2025-02-21 |