| NPI | 1154760932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 67345) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901021011) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN S157) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MI 4301119400) | |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2020-10-20 |