| NPI | 1750678538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MT 13505) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NE 6939) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WY 1474) | |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2022-07-21 |