| NPI | 1609838192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CO 104657) |
| Additional Taxonomies | 207YX0905X Otolaryngology Otolaryngology/Facial Plastic Surgery (Licence: CO 29753) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2023-11-13 |