| NPI | 1659481554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA ds035576) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 2007-00364) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NC 2007-00364) | |
| 208600000X Surgery (Licence: NC 2007-00364) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-05-09 |