| NPI | 1457356057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AZ 62347) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: AZ 10929) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2021-08-14 |