| NPI | 1053330258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA 20354) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: VT 20354) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2023-12-27 |