| NPI | 1073681441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 6650) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 37565) |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2020-06-10 |