| NPI | 1437648292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 111434) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 7500) |
| 122300000X Dentist (Licence: PA DS041940) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: LA 7500) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS041940) | |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2026-06-12 |