| NPI | 1083699920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: IA 40009) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: IA 40009) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2024-09-24 |