| NPI | 1194731836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 4912) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA 11117) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: LA 024422) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: GA 51272) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2019-08-20 |