| NPI | 1548349251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: UT 5219929-9924) |
| Additional Taxonomies | 1223D0004X Dentist Dentist Anesthesiologist (Licence: UT 5219929-9924) |
| 1223P0106X Dentist Oral and Maxillofacial Pathology (Licence: UT 52199299924) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2023-10-17 |