| NPI | 1659448108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX m4965) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 22097) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX M4965) | |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2023-02-23 |