| NPI | 1306200985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AZ 76277) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D012387) |
| Enumeration Date | 2016-04-08 |
| Last Update Date | 2026-08-13 |