| NPI | 1770969008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: LA 7402) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 7402) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2024-04-16 |