| NPI | 1871881292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 30770) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 30770) |
| Enumeration Date | 2011-07-19 |
| Last Update Date | 2016-11-28 |