| NPI | 1427493055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 28894) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX R9727) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2020-05-07 |