| NPI | 1194163618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 30681) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 30681) |
| 122300000X Dentist (Licence: TX 30681) | |
| 122300000X Dentist (Licence: DC DEN1001373) | |
| 122300000X Dentist (Licence: MD 15418) | |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2024-04-30 |