| NPI | 1356320576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 50992) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MN 11819) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: OR D9087) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OR MD29162) | |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2009-04-18 |