| NPI | 1518375054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: SC 9601) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414533) |
| 122300000X Dentist (Licence: SC 9530) | |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0401414533) | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2023-03-16 |