| NPI | 1023088994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 4871) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN009114) |
| 122300000X Dentist (Licence: NC 4871) | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: GA DN009114) | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NC 4871) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN009114) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2012-09-07 |