| NPI | 1184156515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 33097) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX U5124) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2026-05-29 |