| NPI | 1821449273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: WA DE60674528) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60674528) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2022-04-11 |