| NPI | 1952377483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: OR D8702) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WA DE00009493) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2019-12-19 |