| NPI | 1437159332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AK 120881) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: ID D5181OS) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2020-08-14 |