| NPI | 1568674380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 16745) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MD 16745) |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: MD D0090793) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2024-10-07 |