| NPI | 1538894779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61322146) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NM DB-2023-0234) |
| Enumeration Date | 2022-07-21 |
| Last Update Date | 2025-08-19 |