| NPI | 1568872984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: PA DS039692) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414349) |
| Enumeration Date | 2014-05-07 |
| Last Update Date | 2023-06-23 |