| NPI | 1891794806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D7754) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE61472512) |
| 1223G0001X Dentist, General Practice (Licence: WA DE61472512) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2025-08-14 |