| NPI | 1467868901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: GA DN122283) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: GA DNF000432) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: SC 8416) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: GA DNGA000836) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NC 12201) | |
| Enumeration Date | 2014-07-04 |
| Last Update Date | 2023-04-13 |