| NPI | 1275527137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 23649) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 6538) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN23806) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN23806) | |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2020-11-30 |