| NPI | 1326379686 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 14092) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 14092) |
| Enumeration Date | 2010-01-26 |
| Last Update Date | 2022-11-18 |