| NPI | 1285835355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NC 2014-00263) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WV 3897) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 7993) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: WV 24111) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NC 201400263) | |
| Enumeration Date | 2007-05-29 |
| Last Update Date | 2022-08-08 |