| NPI | 1649212168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 11461) |
| Additional Taxonomies | 208VP0000X (Licence: TX 7885) |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2025-09-11 |