| NPI | 1235107046 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 10056) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: SC 9579) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 3460) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL D3460) | |
| 207PE0004X Emergency Medicine, Emergency Medical Services (Licence: AL 10355) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2022-05-04 |