| NPI | 1518552173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN S193) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MD LL875) |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2023-10-17 |