| NPI | 1376520510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401416256) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00009433) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE00009433) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-07-21 |