| NPI | 1629497086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NM DD4275) |
| Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: NM DD4275) |
| 122300000X Dentist (Licence: NM DD4275) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2024-04-11 |