NPI | 1063483733 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE00009411) |
Additional Taxonomies | 122300000X Dentist (Licence: WA DE00009411) |
Enumeration Date | 2006-01-30 |
Last Update Date | 2024-07-03 |