| NPI | 1164686648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NE 25465) |
| Additional Taxonomies | 122300000X Dentist (Licence: NE 25465) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2018-03-29 |