| NPI | 1588189435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: GA DNF000435) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: GA DNF000435) |
| 125Q00000X Oral Medicinist (Licence: GA DNF000435) | |
| Enumeration Date | 2017-08-11 |
| Last Update Date | 2023-04-13 |