| NPI | 1730501032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DD4029) |
| Additional Taxonomies | 122300000X Dentist (Licence: CA 63209) |
| 122300000X Dentist (Licence: NM DD4029) | |
| 1223G0001X Dentist, General Practice (Licence: NM DD4029) | |
| Enumeration Date | 2014-01-07 |
| Last Update Date | 2023-03-24 |