| NPI | 1104168244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL D6030.C1) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 36271) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2020-01-30 |