| NPI | 1295791549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: GA 010345) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: GA 10345) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2019-07-19 |