| NPI | 1427407063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DEN.204363) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22DI02896300) |
| Enumeration Date | 2016-06-05 |
| Last Update Date | 2026-06-29 |