| NPI | 1962798462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 35670) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: PA DS038719) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX S4567) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA MD461668) | |
| Enumeration Date | 2011-06-22 |
| Last Update Date | 2021-05-24 |