| NPI | 1255968053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID D5596) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: ID D5596) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-10-14 |