| NPI | 1144951161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NE 7824) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 7824) |
| Enumeration Date | 2022-06-21 |
| Last Update Date | 2025-05-12 |