| NPI | 1174949374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60830772) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WA DR60468262) |
| Enumeration Date | 2014-03-12 |
| Last Update Date | 2018-07-30 |