| NPI | 1598403099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61292547) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA Pending) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2022-06-21 |