| NPI | 1497148514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 38032) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: AZ d009051) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D009051) | |
| 122300000X Dentist (Licence: AZ D009051) | |
| Enumeration Date | 2015-03-13 |
| Last Update Date | 2024-03-28 |