| NPI | 1235333741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 22370) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 22370) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX 22370) | |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2023-12-20 |