| NPI | 1134120314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: PR 00913) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: PR 00913) |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2025-02-18 |