| NPI | 1689833469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MI 2901020220) |
| Additional Taxonomies | 122300000X Dentist (Licence: CO 9658) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2019-02-12 |