| NPI | 1417245929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL Dn23570) |
| Additional Taxonomies | 122300000X Dentist (Licence: NV 6106) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2020-07-28 |