| NPI | 1952617698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2010019899) |
| Additional Taxonomies | 122300000X Dentist (Licence: MO 2010019899) |
| Enumeration Date | 2010-08-19 |
| Last Update Date | 2022-07-21 |