| NPI | 1982084968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WI 6001447) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: AR 4041) |
| Enumeration Date | 2015-06-04 |
| Last Update Date | 2024-09-18 |