| NPI | 1073016028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MT 144637) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MT DEN-DEN-LIC-28338) |
| Enumeration Date | 2018-03-15 |
| Last Update Date | 2024-10-15 |