| NPI | 1194857227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE00008398) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: WA de00008398) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2023-08-04 |