| NPI | 1265432025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD16391) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: OR D6708) |
| Enumeration Date | 2005-07-22 |
| Last Update Date | 2018-06-11 |