| NPI | 1831680750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE61034697) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE61034697) |
| 122300000X Dentist (Licence: WA DE61034697) | |
| Enumeration Date | 2018-05-26 |
| Last Update Date | 2020-07-22 |