| NPI | 1598765604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901017024) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 2901017024) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2026-08-21 |