| NPI | 1801060967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN 17919) |
| Additional Taxonomies | 122300000X Dentist (Licence: FL 17919) |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2015-09-28 |