| NPI | 1700267408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2952000811) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 36093) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MA DL13260) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WI 18375) | |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2023-01-26 |