| NPI | 1497194765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MO 2013019682) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2013019682) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2018-07-12 |