| NPI | 1316180821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX Q3507) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: TX Q3507) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2022-04-19 |