| NPI | 1407395064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 32003) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 32002) |
| Enumeration Date | 2017-02-15 |
| Last Update Date | 2025-02-24 |