| NPI | 1497765846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DEN.9141) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 9141) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2025-08-25 |