| NPI | 1083927214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 010315) |
| Additional Taxonomies | 122300000X Dentist (Licence: CT 010315) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2024-02-06 |