| NPI | 1992338891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0300X Dentist, Periodontics (Licence: WA 60989143) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: WA DE60989143) |
| Enumeration Date | 2020-02-19 |
| Last Update Date | 2022-06-07 |