| NPI | 1003102435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS043990) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27097) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TX 27097) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 27097) | |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2023-09-13 |