| NPI | 1376060814 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 10285) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS041512) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DEN00205551) | |
| Enumeration Date | 2017-08-25 |
| Last Update Date | 2023-09-18 |