| NPI | 1649464991 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CT 48060) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CT 009948) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2019-10-28 |