| NPI | 1952753964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.027103) |
| Additional Taxonomies | 122300000X Dentist (Licence: PA DS040943) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OK 7556) | |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2023-11-13 |