| NPI | 1245424019 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 27761) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 27761) |
| 122300000X Dentist (Licence: NY 052770-1) | |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TX 27761) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX P2941) | |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2022-07-14 |