| NPI | 1871973438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KS 61613) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: UT 9417127-9921) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KS 61613) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2022-10-04 |