| NPI | 1639250673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: UT 347697-1205) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D12291) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: UT 347697-9924) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN 54113) | |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2022-04-14 |