| NPI | 1770852022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000482) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KS 60898) |
| 1223G0001X Dentist, General Practice (Licence: KS 60898) | |
| Enumeration Date | 2011-12-15 |
| Last Update Date | 2023-06-21 |