| NPI | 1396180436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2017011732) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ BD-6377712-1338) |
| Enumeration Date | 2013-05-02 |
| Last Update Date | 2022-07-21 |