| NPI | 1558123299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WA DENT.DE.61690388) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA DENT.DE.61690388) |
| Enumeration Date | 2024-01-29 |
| Last Update Date | 2026-07-02 |