| NPI | 1245438324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401414248) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: OR d8944) |
| 1223G0001X Dentist, General Practice (Licence: WA de00011246) | |
| 122300000X Dentist (Licence: VA 0401414248) | |
| Enumeration Date | 2007-07-10 |
| Last Update Date | 2021-12-30 |