| NPI | 1497144505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 39236) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401414255) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 061690) | |
| Enumeration Date | 2015-01-13 |
| Last Update Date | 2023-04-18 |