| NPI | 1285014084 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX U5913) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 32373) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901021581) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AL D-0007036-C) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: AL 42397) | |
| Enumeration Date | 2015-06-05 |
| Last Update Date | 2023-08-08 |