| NPI | 1194976332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 6918) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: ID D-4177) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DEN.00205712) | |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2023-09-26 |