| NPI | 1932386851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ AZ1607) |
| Additional Taxonomies | 122300000X Dentist (Licence: AZ AZ1607) |
| 1223X2210X Dentist, Orofacial Pain (Licence: AZ AZ1607) | |
| Enumeration Date | 2008-01-22 |
| Last Update Date | 2024-05-17 |