| NPI | 1568845949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 46593) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63540) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 46593) | |
| Enumeration Date | 2015-07-03 |
| Last Update Date | 2024-05-16 |