| NPI | 1508858176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 32791) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 3778-691OS) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OK 6963) | |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2021-01-25 |