| NPI | 1578189569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NE 9719) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7631) |
| Enumeration Date | 2020-06-25 |
| Last Update Date | 2023-06-28 |