| NPI | 1508087123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN 5145) |
| Additional Taxonomies | 1223P0300X Dentist, Periodontics (Licence: TX 0021958) |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2023-03-22 |