| NPI | 1720067416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: SC 8095) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 7140) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 7140) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2023-09-07 |