| NPI | 1902912355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN11095) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 2800) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2011-04-05 |