| NPI | 1780728998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OR D8996) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WA DE00009935) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2024-03-04 |