| NPI | 1952313892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MI 4301082697) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 4301082697) |
| 122300000X Dentist (Licence: MI 4301082697) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2019-01-29 |