| NPI | 1346505542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MI 2901019840) |
| Additional Taxonomies | 122300000X Dentist (Licence: MI 2901019840) |
| 208600000X Surgery (Licence: MI 4301101198) | |
| Enumeration Date | 2012-07-12 |
| Last Update Date | 2020-12-11 |