| NPI | 1245766906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DN1859762) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: CA 106400) |
| Enumeration Date | 2017-05-02 |
| Last Update Date | 2026-06-30 |