| NPI | 1154858041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: SC 9018) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC 9018) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 9018) | |
| Enumeration Date | 2017-05-22 |
| Last Update Date | 2023-08-16 |