| NPI | 1104095520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: LA 7147) |
| Additional Taxonomies | 122300000X Dentist (Licence: LA 7147) |
| Enumeration Date | 2008-02-29 |
| Last Update Date | 2024-11-12 |