| NPI | 1295091064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0401417047) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401417047) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX R9427) | |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2021-06-04 |