| NPI | 1558776088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WA MD61279945) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS040106) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WA DE61286690) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX S9191) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX 34932) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS040106) | |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2022-06-28 |