| NPI | 1801931209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 5461) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 13636) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: LA 023124) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2007-07-08 |