| NPI | 1922205715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60339865) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ 7240) |
| 1223P0700X Dentist, Prosthodontics (Licence: TX 27917) | |
| 1223P0700X Dentist, Prosthodontics (Licence: WA DE 60339865) | |
| 1223P0700X Dentist, Prosthodontics (Licence: TN 9441) | |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2023-03-07 |