| NPI | 1053579771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 30759) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: NY 054876) |
| 1223G0001X Dentist, General Practice (Licence: KY 8611) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.023877) | |
| Enumeration Date | 2008-05-29 |
| Last Update Date | 2022-04-04 |