| NPI | 1073937223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA DDS09722) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA DDS-09722) |
| Enumeration Date | 2014-02-07 |
| Last Update Date | 2020-05-15 |