| NPI | 1124688841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN123372) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS042192) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: GA DN123372) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS042192) | |
| Enumeration Date | 2019-06-14 |
| Last Update Date | 2025-11-21 |