| NPI | 1770780330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901019634) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019634) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 4090) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2025-02-05 |