| NPI | 1841580453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN26533) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA DL 11218) |
| 122300000X Dentist (Licence: CA SP292) | |
| 125Q00000X Oral Medicine (Licence: FL DN26533) | |
| Enumeration Date | 2011-04-15 |
| Last Update Date | 2024-06-12 |