| NPI | 1144675422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NC 12176) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: NC 12176) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 12176) | |
| Enumeration Date | 2016-04-25 |
| Last Update Date | 2026-02-05 |