| NPI | 1972024552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE61466994) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D10687) |
| Enumeration Date | 2017-07-04 |
| Last Update Date | 2024-08-16 |