| NPI | 1639281983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist Dental Public Health (Licence: WA DE00009828) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: OR D7547) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2020-10-21 |