| NPI | 1437531209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: IA 9895) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MO 2015020284) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2021-07-26 |