| NPI | 1649717596 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 82819) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: LA 7650) |
| Enumeration Date | 2017-01-30 |
| Last Update Date | 2026-09-10 |