| NPI | 1518051028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00009443) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE9443) |
| 1223G0001X Dentist, General Practice (Licence: WA 9443) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2024-03-25 |