| NPI | 1538471057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401416727) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 25469) |
| Enumeration Date | 2010-07-13 |
| Last Update Date | 2022-11-29 |