| NPI | 1164080867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OK 237) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 7178) |
| Enumeration Date | 2019-05-29 |
| Last Update Date | 2025-08-27 |