| NPI | 1356828347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA 61404526) |
| Additional Taxonomies | 122300000X Dentist (Licence: KY 10101) |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2023-09-06 |