| NPI | 1831276641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D8019) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WA D00009300) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-04-07 |