| NPI | 1417155821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0438000245) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401412132) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901018153) | |
| Enumeration Date | 2007-07-06 |
| Last Update Date | 2018-08-02 |