| NPI | 1538281068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE 00010267) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D8390) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA GA10000414) | |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2015-08-10 |