| NPI | 1285750166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN012756) |
| Additional Taxonomies | 122300000X Dentist (Licence: GA DN012756) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 4292) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2012-06-21 |