| NPI | 1821518937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122400000X Denturist (Licence: WA NT003) |
| Additional Taxonomies | 122400000X Denturist (Licence: SD UB204630) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2023-03-07 |