| NPI | 1811163611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60377088) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WA MD60383921) |
| 1223D0004X Dentist, Dentist Anesthesiologist Speciality (Licence: WA GA60383740) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WA DE60377088) | |
| 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: WA MD60383921) | |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2019-04-17 |