| NPI | 1659959203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 108301) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE61325333) |
| Enumeration Date | 2021-04-01 |
| Last Update Date | 2022-12-29 |