| NPI | 1154385185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WV 18520) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 3328) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2023-06-20 |