| NPI | 1710178538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 7517) |
| Additional Taxonomies | 122300000X Dentist (Licence: ID D-4096) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2019-09-19 |