| NPI | 1447791454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 38087) |
| Additional Taxonomies | 125K00000X Advanced Practice Dental Therapist (Licence: FL 00000) |
| Enumeration Date | 2017-03-10 |
| Last Update Date | 2022-07-23 |