| NPI | 1851609713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 36986) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 7726693-9921) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: UT 7726693-9921) | |
| Enumeration Date | 2010-09-14 |
| Last Update Date | 2023-07-08 |