| NPI | 1760991244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: ID D-5307) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA 60749885) |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2022-10-04 |