| NPI | 1487328696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 39742) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: FL 2367) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 39742) | |
| Enumeration Date | 2021-08-03 |
| Last Update Date | 2023-12-15 |