| NPI | 1386849446 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ND 13411) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ND 2230) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: ND 13411) | |
| Enumeration Date | 2007-06-19 |
| Last Update Date | 2021-10-27 |