| NPI | 1245608546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN30921) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 32814) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401417810) | |
| Enumeration Date | 2015-09-03 |
| Last Update Date | 2025-08-26 |