| NPI | 1699349506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE61405267) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE61405267) |
| Enumeration Date | 2021-05-14 |
| Last Update Date | 2026-05-20 |