| NPI | 1487901336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NV S2-199C) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-199C) |
| Enumeration Date | 2012-08-10 |
| Last Update Date | 2024-10-01 |