| NPI | 1871602854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901017447) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901017447) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2024-06-13 |