| NPI | 1679912711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 37328) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 37328) |
| 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TX 37328) | |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2025-05-13 |