| NPI | 1598146763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D13524) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13524) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN 65986) | |
| Enumeration Date | 2015-06-14 |
| Last Update Date | 2021-07-26 |