| NPI | 1386701290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 30648) |
| Additional Taxonomies | 122300000X Dentist (Licence: MA 9261) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401413537) | |
| 1223P0700X Dentist, Prosthodontics (Licence: TX 30648) | |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2024-02-19 |