| NPI | 1497164081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 10106) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414463) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DNF000451) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: GA DNF000451) | |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2024-01-11 |