| NPI | 1790898708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE00008332) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WA MD00035615) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2007-07-09 |