| NPI | 1699793737 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 5366) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 5366) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2010-05-04 |