| NPI | 1790127769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL 1131) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 1131) |
| Enumeration Date | 2013-07-19 |
| Last Update Date | 2019-04-10 |