| NPI | 1457583742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 56519) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D12742) |
| Enumeration Date | 2009-08-20 |
| Last Update Date | 2013-10-16 |