| NPI | 1790210292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 38331) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 38331) |
| Enumeration Date | 2017-04-22 |
| Last Update Date | 2024-06-13 |