| NPI | 1760542153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: WA 912093415) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: WA DE00006691) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2024-05-01 |