| NPI | 1528554466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: NE 34965) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NE 34965) |
| Enumeration Date | 2018-07-03 |
| Last Update Date | 2023-11-21 |