| NPI | 1689839805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN015617) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA ds037611) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2022-08-18 |