| NPI | 1811980576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 5570) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 5570) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: LA 5570) | |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2018-10-18 |