| NPI | 1023329901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: OK 32110) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: FL DN20350) |
| Enumeration Date | 2010-06-25 |
| Last Update Date | 2016-08-08 |