| NPI | 1336258151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 20841) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID 7961261) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA 61585472) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2025-06-18 |