| NPI | 1619436425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: UT 13788895-9924) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: WI 1002257-15) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MN D14380) | |
| Enumeration Date | 2019-03-19 |
| Last Update Date | 2024-07-07 |