| NPI | 1437380359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL ME118723) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: FL DN18079) |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2020-03-05 |