| NPI | 1679840243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 16451) |
| Additional Taxonomies | 122300000X Dentist (Licence: NJ 22d102485300) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NJ 22d102485300) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401415763) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DC DEN1001786) | |
| Enumeration Date | 2011-11-25 |
| Last Update Date | 2022-07-21 |