| NPI | 1245526722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: ND 15144) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DL-11263) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2018-07-09 |