| NPI | 1720472855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TN DS0000010713) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN DS0000010713) |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2025-05-28 |