| NPI | 1811041742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5414) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: WI 5414015) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2025-09-03 |