| NPI | 1063532059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 4139) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN2333) |
| 122300000X Dentist (Licence: DC DEN2333) | |
| Enumeration Date | 2007-03-31 |
| Last Update Date | 2024-04-25 |