| NPI | 1306254396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 11351) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: WV RP0008665) |
| 122300000X Dentist (Licence: WV 4524) | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2026-07-17 |