| NPI | 1063485829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AZ 43835) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 11990) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN 51977) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ 07855) | |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2013-04-30 |