| NPI | 1972172971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 42724) |
| Additional Taxonomies | 122300000X Dentist (Licence: TX 42724) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 00204758) | |
| 122300000X Dentist (Licence: CO 00204758) | |
| Enumeration Date | 2021-06-23 |
| Last Update Date | 2026-07-14 |