| NPI | 1346651007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE60341917) |
| Additional Taxonomies | 122300000X Dentist (Licence: TN 10927) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TN DS0000010927) | |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2024-02-13 |