| NPI | 1053628305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL 26619) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 7693796-9921) |
| Enumeration Date | 2010-09-08 |
| Last Update Date | 2022-03-21 |