| NPI | 1033524871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: GA DNF000452) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9451) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DNF000452) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 104919) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 9451) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: GA 92043) | |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2023-04-13 |