| NPI | 1104575067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN10000686) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA 1022800) |
| Enumeration Date | 2022-03-19 |
| Last Update Date | 2026-05-31 |