| NPI | 1417357146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN1001421) |
| Additional Taxonomies | 122300000X Dentist (Licence: DC DEN1001421) |
| 171000000X Military Health Care Provider (Licence: DC DEN1001421) | |
| Enumeration Date | 2014-08-29 |
| Last Update Date | 2024-08-14 |