| NPI | 1346383486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: DE C1-0010973) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0438000397) |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2024-03-22 |