| NPI | 1730486630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D009562) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: AZ D009562) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN10000125) | |
| Enumeration Date | 2011-02-12 |
| Last Update Date | 2024-05-29 |