| NPI | 1629337506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 61209) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D13132) |
| Enumeration Date | 2012-05-11 |
| Last Update Date | 2017-05-16 |