| NPI | 1952505984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WA 60266972) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN D12473) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60266972) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D9701) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OR D9701) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2014-11-25 |