| NPI | 1376705087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 6460) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: LA MD.207238) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2025-07-01 |