| NPI | 1659594646 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60074986) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D3977) |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2021-02-26 |