| NPI | 1851353957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 20286) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 20286) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 20286) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2019-08-26 |