| NPI | 1013586866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D012728) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.027383) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: AZ 79644) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OH 35.150020) | |
| Enumeration Date | 2021-06-24 |
| Last Update Date | 2026-03-17 |