| NPI | 1659562775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD60628000) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DF60668028) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2017-08-28 |