| NPI | 1639338304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: WV 3957) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MD 16311) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2018-06-06 |