| NPI | 1174501092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 53367) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D12144) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2010-11-22 |