| NPI | 1912517228 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61217627) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D11278) |
| Enumeration Date | 2020-08-03 |
| Last Update Date | 2023-02-21 |