NPI | 1255873345 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE61424421) |
Additional Taxonomies | 122300000X Dentist (Licence: CA DDS100351) |
Enumeration Date | 2016-11-07 |
Last Update Date | 2024-01-26 |