| NPI | 1942974159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: AL D-0006958-C1) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE61416925) |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2023-07-14 |