| NPI | 1912341074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN1001730) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: DC DEN1001730) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401415594) | |
| Enumeration Date | 2013-04-19 |
| Last Update Date | 2023-10-12 |