| NPI | 1215077847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MN S20) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: WI 5001916) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN S20) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2024-01-09 |