| NPI | 1992902423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: CO 9645) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 2643) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO DEN00009645) | |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2023-01-03 |