| NPI | 1821526708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE60769612) |
| Additional Taxonomies | 1223D0001X Dentist, Dental Public Health (Licence: WA rr60670198) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2022-07-21 |