| NPI | 1356502041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2010008033) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NC 12181) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: KS 60659) | |
| Enumeration Date | 2008-06-24 |
| Last Update Date | 2021-06-24 |