| NPI | 1275858169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60634547) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA MD60644029) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 58655) | |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2020-02-24 |