| NPI | 1093862997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MO 2003012137) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NM DD2684) |
| Enumeration Date | 2007-01-04 |
| Last Update Date | 2024-04-10 |