| NPI | 1700267408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901601665) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WI 18375) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 36093) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MA DL13260) | |
| Enumeration Date | 2015-06-18 |
| Last Update Date | 2026-03-13 |