| NPI | 1578548681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223E0200X Dentist, Endodontics (Licence: GA DN014506) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00007767) |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2023-12-28 |