NPI | 1144396763 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WA 60027252) |
Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA 60016824) |
Enumeration Date | 2006-11-27 |
Last Update Date | 2012-01-05 |