| NPI | 1508393414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN10000656) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA 1022311) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2025-05-09 |