| NPI | 1063492981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: UT 6632857) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL 5134) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WA DE00010382) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2023-05-22 |