| NPI | 1326025461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2019010704) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D11270) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KS 61570) | |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2021-03-19 |