| NPI | 1659894970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61196983) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D10683) |
| Enumeration Date | 2017-07-18 |
| Last Update Date | 2024-07-17 |