| NPI | 1699756502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL 18541) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 7406) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2023-10-20 |