| NPI | 1184603136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DNF000430) |
| Additional Taxonomies | 122300000X Dentist (Licence: IA DDS08292) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA DDS08292) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2019-12-06 |