| NPI | 1861899163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901021245) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901021245) |
| Enumeration Date | 2014-12-02 |
| Last Update Date | 2022-09-30 |