| NPI | 1932604501 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 17303) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: DC DEN2000121) |
| Enumeration Date | 2018-03-27 |
| Last Update Date | 2022-06-08 |