| NPI | 1467175521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2952000239) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ZZ 2952000239) |
| 122300000X Dentist (Licence: MI 2952000239) | |
| Enumeration Date | 2022-09-23 |
| Last Update Date | 2022-10-24 |