| NPI | 1770826224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 2019-00625) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR MD198730) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D9916) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2020-06-15 |