| NPI | 1518166313 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: CA 108365) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00011027) |
| Enumeration Date | 2007-07-12 |
| Last Update Date | 2025-09-05 |