| NPI | 1619061546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 1002515) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 315501-9924) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: UT 315501-1205) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2021-11-24 |