| NPI | 1689750390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 63977) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00009519) |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2024-06-06 |