| NPI | 1083066021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OK RES1324) |
| Additional Taxonomies | 174400000X Specialist |
| 208600000X Surgery (Licence: OK RES1324) | |
| Enumeration Date | 2016-07-01 |
| Last Update Date | 2020-05-28 |