| NPI | 1851868129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401416341) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 17905) |
| 1223G0001X Dentist, General Practice (Licence: VA 0401416341) | |
| Enumeration Date | 2018-10-25 |
| Last Update Date | 2024-10-28 |