| NPI | 1477087898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AL D007143D) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: KY 9978) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2023-09-08 |