| NPI | 1902136989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D9383) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE60123701) |
| Enumeration Date | 2010-01-13 |
| Last Update Date | 2023-10-11 |