| NPI | 1356508493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WI 1002341-15) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NY 053798) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: DC DEN1000891) | |
| Enumeration Date | 2008-05-16 |
| Last Update Date | 2021-11-15 |