| NPI | 1043440068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D011165) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 1223G0001X Dentist, General Practice (Licence: TX 24806) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DR60213519) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE6048933) | |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2024-06-18 |