| NPI | 1437320926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NV S2-20) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NV S220) |
| Enumeration Date | 2008-03-12 |
| Last Update Date | 2010-06-16 |