| NPI | 1497493142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MT DEN-DEN-LIC-33232) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MT DEN-DEN-LIC-33232) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WY 1719) | |
| Enumeration Date | 2022-05-23 |
| Last Update Date | 2026-07-10 |