| NPI | 1619174877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 1001664) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IA 08480) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN S70) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE 60277199) | |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2024-04-10 |