| NPI | 1457318057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 17244) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 5088) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN 9045) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2023-03-07 |