| NPI | 1215038740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IA 9730) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MT 10768) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NE 6220) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2021-10-21 |