| NPI | 1497117402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 38174) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 38174) |
| Enumeration Date | 2016-03-28 |
| Last Update Date | 2024-02-09 |