| NPI | 1730184771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0700X Dentist, Prosthodontics (Licence: WA DE60267320) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE60267320) |
| 122300000X Dentist (Licence: CA 45603) | |
| 1223P0700X Dentist, Prosthodontics (Licence: CA 45603) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2025-08-01 |