| NPI | 1831106293 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60305935) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 54239) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2021-10-25 |