| NPI | 1215927181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: NE 18887) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 5504) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2023-09-11 |