| NPI | 1457574048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL DN7727) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: FL DN7727) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-10-27 |