| NPI | 1740594571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: OR D11020) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ D008567) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DE G3-0000378) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D11020) | |
| Enumeration Date | 2010-08-04 |
| Last Update Date | 2022-03-23 |