| NPI | 1659752038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 31291) |
| Additional Taxonomies | 286500000X Military Hospital |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2023-06-05 |