| NPI | 1588962781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: ND 16610) |
| Additional Taxonomies | 122300000X Dentist (Licence: ND 2398) |
| Enumeration Date | 2011-03-11 |
| Last Update Date | 2022-03-28 |