| NPI | 1578915906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: KS 61946) |
| Additional Taxonomies | 122300000X Dentist (Licence: VA 0401415307) |
| 122300000X Dentist (Licence: KS 61946) | |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2023-05-09 |