| NPI | 1619192424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: UT 145198-9924) |
| Additional Taxonomies | 2086S0122X Surgery, Plastic and Reconstructive Surgery (Licence: UT 1451989924) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2014-02-18 |