| NPI | 1194241505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 10404795-9926) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 7499) |
| Enumeration Date | 2017-08-17 |
| Last Update Date | 2024-08-07 |