| NPI | 1962619684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA 243648) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D8485) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2023-01-09 |