| NPI | 1922299445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D9841) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D9841) |
| 1223G0001X Dentist, General Practice (Licence: HI dt2311) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: HI DT2311) | |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2024-02-06 |