| NPI | 1679878938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: UT 12396150) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AZ 9349) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NV 6492) | |
| Enumeration Date | 2011-01-18 |
| Last Update Date | 2022-07-22 |