| NPI | 1619243482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 28622) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KY 9715) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KY 9715) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX 28622) | |
| Enumeration Date | 2012-03-27 |
| Last Update Date | 2020-11-04 |