| NPI | 1164712022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DEN.00204638) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D9861) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD190558) | |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2021-07-01 |