| NPI | 1063472876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN008224) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DNGA000207) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 0222) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 2139) | |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2026-04-07 |