| NPI | 1245440676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OR D10398) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: LA S-476) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2018-11-08 |