| NPI | 1811961394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 8631) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: CO 8631) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2011-07-20 |