| NPI | 1659368447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 12550699-9925) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID D-3314-OS) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WY 1506) | |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2022-04-20 |