| NPI | 1477782266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 33599) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2009-015-880) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DD4485) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX R6485) | |
| Enumeration Date | 2009-07-14 |
| Last Update Date | 2024-02-20 |