| NPI | 1821384827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DENT.DE.60637729) |
| Additional Taxonomies | 122300000X Dentist (Licence: KS 60834) |
| 1223G0001X Dentist, General Practice (Licence: WA DENT.DE.60637729) | |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2026-05-28 |