| NPI | 1144755976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN015448) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: GA DN015448) |
| Enumeration Date | 2017-04-30 |
| Last Update Date | 2024-04-24 |