| NPI | 1346403235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 6498-15) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 8018) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 54467-20) | |
| Enumeration Date | 2008-07-09 |
| Last Update Date | 2010-07-29 |