| NPI | 1588194328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 38359) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: IL 018.002025) |
| Enumeration Date | 2017-06-14 |
| Last Update Date | 2022-09-08 |