| NPI | 1174254767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS044498) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 6001112-15) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN27637) | |
| Enumeration Date | 2022-06-23 |
| Last Update Date | 2025-03-20 |