| NPI | 1972504439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DE00009681) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: HI dt3456) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2025-06-13 |