| NPI | 1326694845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN24506) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MS 111699) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL D.0006679-C1) | |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2025-10-30 |