| NPI | 1487265039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 7739) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401417118) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AR 4883) | |
| Enumeration Date | 2020-08-16 |
| Last Update Date | 2025-10-31 |