| NPI | 1467930545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE.61279080) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401416230) |
| Enumeration Date | 2018-08-01 |
| Last Update Date | 2024-09-16 |