| NPI | 1316968035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: KS 6423) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: KS 6423) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2023-03-07 |