| NPI | 1427127422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: UT 4947070-9924) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 2901018951) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MI 2901018951) | |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2019-04-15 |