| NPI | 1679554513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 10246) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA 231511) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA 20571) | |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2019-03-14 |