| NPI | 1730636242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN122934) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL DN22206) |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2022-12-27 |