| NPI | 1487786844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WA DE00004943) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OR D4952) |
| Enumeration Date | 2007-03-12 |
| Last Update Date | 2010-10-14 |