| NPI | 1851827158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN015396) |
| Additional Taxonomies | 125Q00000X Oral Medicinist (Licence: GA DN015396) |
| Enumeration Date | 2017-05-04 |
| Last Update Date | 2021-08-31 |