| NPI | 1083029573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 35860) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 35860) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OK 6635) | |
| 1223G0001X Dentist, General Practice (Licence: OK 6635) | |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2020-01-28 |