| NPI | 1427194364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: ND T2400) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NM DD2840) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WY 1160) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 12562) | |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2020-07-13 |