| NPI | 1154679884 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 28214) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 28214) |
| Enumeration Date | 2012-08-28 |
| Last Update Date | 2025-06-23 |