| NPI | 1558688309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: LA MD.302913) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX U0177) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2024-11-21 |