| NPI | 1538416359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D011768) |
| Additional Taxonomies | 122300000X Dentist (Licence: UT 8357668-9921) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2024-07-11 |