| NPI | 1982130779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN31531) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 110745) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 33185) | |
| 171000000X Military Health Care Provider | |
| Enumeration Date | 2017-05-11 |
| Last Update Date | 2026-07-16 |