| NPI | 1467707018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OH 35.133569) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: OH 30.025324) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2012024880) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MO 2015020404) | |
| Enumeration Date | 2012-07-19 |
| Last Update Date | 2018-08-22 |