| NPI | 1134147309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WA 6293) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA 6293) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OR D9479) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D9479) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2014-11-25 |