| NPI | 1689762437 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA 7426) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 7426) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2023-11-29 |