| NPI | 1376991794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN22297) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040820) |
| Enumeration Date | 2016-05-26 |
| Last Update Date | 2021-07-27 |