| NPI | 1962802769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 8387) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 8387) |
| Enumeration Date | 2014-08-28 |
| Last Update Date | 2023-09-25 |