| NPI | 1629050653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60386478) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 15548) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA 010950) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 7885) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 34606) | |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2013-09-25 |