| NPI | 1538147848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ND 2025) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 11700) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN 49823) | |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2019-05-24 |