| NPI | 1619255346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 31758) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: ME 4195) |
| 1223G0001X Dentist General Practice (Licence: ME 4195) | |
| 1223G0001X Dentist General Practice (Licence: TX 31758) | |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2023-09-19 |