| NPI | 1801316435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KS 62076) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2017019368) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MO 2017019368) | |
| Enumeration Date | 2017-06-24 |
| Last Update Date | 2025-08-22 |