| NPI | 1588235709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE70016665) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DENT.DE.70016665) |
| 171R00000X Interpreter (Licence: WA MA4305) | |
| Enumeration Date | 2021-07-08 |
| Last Update Date | 2025-10-07 |