| NPI | 1497162358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13402) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 64354) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN 64354) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN D13402) | |
| Enumeration Date | 2014-07-11 |
| Last Update Date | 2026-06-15 |