| NPI | 1689994923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 7829973-9922) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ID D-5108-OS) |
| Enumeration Date | 2010-06-09 |
| Last Update Date | 2022-11-15 |