| NPI | 1093062861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN122897) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 8135) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 10316) | |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2023-03-01 |