| NPI | 1285920769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NC 11509) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MA DL-11243) |
| Enumeration Date | 2011-06-23 |
| Last Update Date | 2019-06-26 |