| NPI | 1679093603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 16449) |
| Additional Taxonomies | 208600000X Surgery (Licence: MD D0096480) |
| Enumeration Date | 2017-06-21 |
| Last Update Date | 2025-09-09 |