| NPI | 1992284012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WA DENT.DE.61475754) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR D10879) |
| Enumeration Date | 2018-08-09 |
| Last Update Date | 2026-01-05 |