| NPI | 1821349655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 10484) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 33608) |
| 122300000X Dentist (Licence: UT 8343735-9921) | |
| Enumeration Date | 2012-09-19 |
| Last Update Date | 2025-10-05 |