| NPI | 1083078554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 68180) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13719) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN 29838) | |
| Enumeration Date | 2016-04-11 |
| Last Update Date | 2023-03-30 |