| NPI | 1891867875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00008483) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA 00008483) |
| 125Q00000X Oral Medicine (Licence: WA 00008483) | |
| 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: WA 00008483) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2026-08-07 |