| NPI | 1497712186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 55317) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 55317) |
| 122300000X Dentist (Licence: WA DE00010400) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401415272) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2022-11-17 |