| NPI | 1548527104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 15840) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: DE G1-0001385) |
| Enumeration Date | 2012-04-19 |
| Last Update Date | 2018-08-20 |