| NPI | 1619356672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 7212) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13863) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN 65958) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN R622) | |
| Enumeration Date | 2015-05-23 |
| Last Update Date | 2021-11-01 |