| NPI | 1508991951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00006183) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 6183) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2022-04-28 |