| NPI | 1649790536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000460) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: VA 0401415652) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 063842) | |
| Enumeration Date | 2017-06-22 |
| Last Update Date | 2024-07-30 |