| NPI | 1700943883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: DC DEN2524) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 5342) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2020-07-08 |