| NPI | 1205156478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 201974) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 76826359922) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2023-11-02 |