| NPI | 1336509397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IA 10085) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: IA 10085) |
| Enumeration Date | 2016-03-03 |
| Last Update Date | 2023-11-03 |