| NPI | 1033207097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 26173) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX G9851) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2022-03-31 |