| NPI | 1609578418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122400000X Denturist (Licence: WA DN60939854) |
| Additional Taxonomies | 261QD0000X Clinic/Center, Dental |
| 292200000X Dental Laboratory | |
| Enumeration Date | 2023-03-17 |
| Last Update Date | 2023-03-17 |