| NPI | 1871804781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000355) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401414186) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401414186) | |
| Enumeration Date | 2010-06-24 |
| Last Update Date | 2021-09-23 |