| NPI | 1598886681 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR 9034) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CA 112883) |
| 122300000X Dentist (Licence: WA 60273277) | |
| Enumeration Date | 2007-04-03 |
| Last Update Date | 2026-06-25 |