| NPI | 1043269640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MO 2018012849) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: GA DN013126) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2018-08-30 |