| NPI | 1083876478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MT 4079DENTAL) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MT DEN-DEN-LIC-4079) |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2018-03-13 |