| NPI | 1518110329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX P7351) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MD D73838) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: OR FE156073) | |
| Enumeration Date | 2008-10-24 |
| Last Update Date | 2018-03-17 |