| NPI | 1588979009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 2901017389) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: NH 03796) |
| Enumeration Date | 2010-08-09 |
| Last Update Date | 2023-02-15 |