| NPI | 1285952895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 25908) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D010221) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OH 30 024690) | |
| Enumeration Date | 2010-05-06 |
| Last Update Date | 2022-01-22 |