| NPI | 1679801922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: UT 12488498-9926) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60102367) |
| Enumeration Date | 2009-11-25 |
| Last Update Date | 2025-08-06 |