| NPI | 1215433685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NC 202500269) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 11013) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TN 73026) | |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2025-04-01 |