| NPI | 1942287081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 12698) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: MN d12162) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D12162) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2023-03-07 |