| NPI | 1821015686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 824) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DNF000321) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 8324) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2026-10-14 |