| NPI | 1417237876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 9767) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 10933) |
| 1223G0001X Dentist, General Practice (Licence: SC 7019) | |
| Enumeration Date | 2011-08-17 |
| Last Update Date | 2024-04-22 |