| NPI | 1376705038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MI 2901019878) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 4301100207) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2020-10-20 |