| NPI | 1528554466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: UT 13593976-1205) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NE 34965) |
| 208600000X Surgery (Licence: NE 34965) | |
| 208600000X Surgery (Licence: UT 13593976-1205) | |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2024-12-19 |