| NPI | 1578132627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NE 9975) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 7733) |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2024-08-02 |