| NPI | 1538300058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1859071) |
| Additional Taxonomies | 122300000X Dentist (Licence: MD 14341) |
| 122300000X Dentist (Licence: DC 1000778) | |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2021-11-22 |