| NPI | 1952503492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: LA P-203) |
| Additional Taxonomies | 122300000X Dentist (Licence: NC 150430) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA P-203) | |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2023-03-01 |