| NPI | 1336350537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AZ 011052) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 38144) |
| Enumeration Date | 2007-05-28 |
| Last Update Date | 2021-08-05 |