| NPI | 1427023126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 43848) |
| Additional Taxonomies | 208600000X Surgery (Licence: OR MD24022) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OR D8138) | |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2020-08-11 |