| NPI | 1952753964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CT 13740) |
| Additional Taxonomies | 208600000X Surgery (Licence: CT 75128) |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2025-05-16 |