| NPI | 1033484944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN24505) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN24505) |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2026-07-06 |