| NPI | 1396279949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0401415704) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401415704) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2024-01-29 |