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 |