| NPI | 1083276539 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN24400) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS043532) |
| 1223G0001X Dentist, General Practice (Licence: FL DN24400) | |
| Enumeration Date | 2019-07-05 |
| Last Update Date | 2023-04-22 |