| NPI | 1295776011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 13358) |
| Additional Taxonomies | 1223P0106X Dentist, Oral and Maxillofacial Pathology (Licence: TX 13358) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 13358) | |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2021-07-13 |