| NPI | 1790003440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN015544) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401413562) |
| 125Q00000X Oral Medicinist (Licence: MA DN1857012) | |
| Enumeration Date | 2010-05-05 |
| Last Update Date | 2019-03-25 |