| NPI | 1457441842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AZ D009102) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00010333) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2024-03-13 |