| NPI | 1013418185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL 166526) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL 29367) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 318937) | |
| Enumeration Date | 2018-02-23 |
| Last Update Date | 2025-08-02 |