| NPI | 1487027538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 60902595) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D009363) |
| Enumeration Date | 2015-11-10 |
| Last Update Date | 2024-02-20 |