| NPI | 1720570393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: GA DN124162) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: RI DEN03731) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401416112) | |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2026-07-29 |