| NPI | 1659460772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: GA DN009961) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: GA DN9961) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2020-04-23 |