| NPI | 1487271425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA 61085039) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA TP61085485) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2023-01-31 |