| NPI | 1336397587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 56542) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D12638) |
| Enumeration Date | 2008-08-29 |
| Last Update Date | 2020-08-13 |