| NPI | 1548222730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DD5435) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 055981) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KS 60516) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 36927) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2023-01-25 |