| NPI | 1518122845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901601218) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: LA 302017) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2023-12-20 |