| NPI | 1205908977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: GA DN011039) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: GA 011039) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2012-05-11 |