| NPI | 1265662985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN1001793) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 15335) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2020-05-27 |