| NPI | 1811994189 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WA 7577) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 26557) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 18499) | |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2011-08-29 |