| NPI | 1568432318 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 5929961-9921) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60118200) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2023-06-26 |