| NPI | 1962713289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NC 2017-02428) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TN 10241) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TN 54513) | |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2018-03-17 |