| NPI | 1679801039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60459097) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60459097) |
| 1223G0001X Dentist, General Practice (Licence: AK 1324) | |
| Enumeration Date | 2009-11-24 |
| Last Update Date | 2024-10-28 |