| NPI | 1902474760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NE 10072) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 7731) |
| 122300000X Dentist (Licence: MI 2901600937) | |
| Enumeration Date | 2021-06-16 |
| Last Update Date | 2024-06-28 |