| NPI | 1255778668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: TX 30534) |
| Additional Taxonomies | 122300000X Dentist (Licence: OK 6491) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OK 231) | |
| Enumeration Date | 2013-05-24 |
| Last Update Date | 2023-01-06 |