| NPI | 1740520840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA MD479395) |
| Additional Taxonomies | 122300000X Dentist (Licence: WA 60369665) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA S-742) | |
| Enumeration Date | 2013-02-26 |
| Last Update Date | 2023-04-24 |