| NPI | 1770983355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 12696) |
| Additional Taxonomies | 125Q00000X Oral Medicine (Licence: NC 12696) |
| Enumeration Date | 2014-09-02 |
| Last Update Date | 2026-07-15 |