| NPI | 1447799937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MO 2022005805) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MO 2022005805) |
| Enumeration Date | 2017-02-16 |
| Last Update Date | 2022-07-11 |