| NPI | 1205089851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2014041682) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D008751) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 82708249924) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DR 60035403) | |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2021-03-02 |