| NPI | 1497881734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60051632) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SD M766) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2021-09-29 |