| NPI | 1043415870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD161538) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OR D10370) |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2020-10-02 |