| NPI | 1669601886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: WA DE60690890) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2009015337) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2024-11-25 |