| NPI | 1952595605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DD4423) |
| Additional Taxonomies | 122300000X Dentist (Licence: NM DD4423) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2021-08-10 |