| NPI | 1477000164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 38275) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR PG188470) |
| 122300000X Dentist (Licence: OR D10527) | |
| 122300000X Dentist (Licence: TX 38275) | |
| 208600000X Surgery (Licence: TX T6917) | |
| Enumeration Date | 2016-09-09 |
| Last Update Date | 2023-01-02 |