| NPI | 1326296120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D6934) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NE 3394) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2008-09-24 |