| NPI | 1861855132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D11591) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE61251169) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD210269) | |
| Enumeration Date | 2016-04-03 |
| Last Update Date | 2022-05-26 |