| NPI | 1942474077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NC 2013-01211) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 5773) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 201301211) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 10784) | |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2026-01-09 |