| NPI | 1922365402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-144C) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 58883) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60351030) | |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2016-06-27 |