| NPI | 1780010025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D14299) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 7117) |
| Enumeration Date | 2013-09-18 |
| Last Update Date | 2019-08-01 |