| NPI | 1366058356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MI 2952000720) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2952000720) |
| Enumeration Date | 2020-09-16 |
| Last Update Date | 2020-10-19 |