| NPI | 1447364914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: OR 4806) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE00008439) |
| 122300000X Dentist (Licence: VA 0401008461) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2022-07-21 |