| NPI | 1447668751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 35893) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DE 60483479) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA 60483479) | |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2021-01-12 |