| NPI | 1124465265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MS 4396-23) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS039580) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS039580) | |
| Enumeration Date | 2013-05-30 |
| Last Update Date | 2024-01-16 |