| NPI | 1417067497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 19097) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX K0551) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX 19097) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-02-23 |