| NPI | 1396292876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 10125) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: TX 32072) |
| 1223P0700X Dentist, Prosthodontics (Licence: SC 10128) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 32072) | |
| Enumeration Date | 2016-09-01 |
| Last Update Date | 2022-08-11 |