| NPI | 1720393457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NE 7586) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: CA 60618) |
| Enumeration Date | 2010-08-18 |
| Last Update Date | 2019-10-18 |