| NPI | 1841470994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 6217) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NE 6638) |
| 122300000X Dentist (Licence: WI 6217-005) | |
| Enumeration Date | 2007-11-06 |
| Last Update Date | 2014-04-24 |