| NPI | 1689085961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208600000X Surgery (Licence: NY 311169) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OK OS215) |
| Enumeration Date | 2014-05-08 |
| Last Update Date | 2021-11-23 |