| NPI | 1881907988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 5787) |
| Additional Taxonomies | 122300000X Dentist (Licence: AL 5787 C1) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS 4192-21) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 7276) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 5787) | |
| Enumeration Date | 2010-07-17 |
| Last Update Date | 2023-08-21 |