| NPI | 1790136380 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 11826340-9925) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NV S2-175C) |
| Enumeration Date | 2016-06-25 |
| Last Update Date | 2020-11-18 |