| NPI | 1093154601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 1001979-15) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: WI 72801-20) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2020-06-15 |