| NPI | 1225773153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 14747) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN31109) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN10001434) | |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2026-06-23 |