| NPI | 1528598695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 33093) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX U8734) |
| Enumeration Date | 2017-06-12 |
| Last Update Date | 2024-07-01 |