| NPI | 1649578600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60471936) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA deuw.dr.60288643) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 32385) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WA deuw.dr.60288643) | |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2011-03-01 |
| Last Update Date | 2019-10-18 |