| NPI | 1881848786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00009660) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE 00009660) |
| Enumeration Date | 2008-11-05 |
| Last Update Date | 2021-12-30 |