| NPI | 1669460119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223D0001X Dentist, Dental Public Health (Licence: WA DE60034739) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 5507) |
| Enumeration Date | 2005-10-10 |
| Last Update Date | 2023-08-03 |