| NPI | 1629073465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN013416) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: GA DN013416) |
| 261QD0000X Clinic/Center, Dental (Licence: GA DN013416) | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: GA DN013416) | |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2011-07-01 |