| NPI | 1174182414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DN1858982) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DL14005) |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2021-07-01 |