| NPI | 1225013022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: ND 15017) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: ND 2332) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: ND PT15017) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: AZ 32072) | |
| 207Y00000X Otolaryngology (Licence: AZ 32072) | |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2022-04-29 |