| NPI | 1457994980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1859729) |
| Additional Taxonomies | 208600000X Surgery (Licence: MA 1016683) |
| Enumeration Date | 2019-10-28 |
| Last Update Date | 2024-03-20 |