| NPI | 1104051473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CO 55063) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 6630) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CO 202453) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS039194) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA A118747) | |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2021-05-11 |