| NPI | 1679809958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MD 16275) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: VA 0401415902) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: DC DEN1001847) | |
| Enumeration Date | 2009-10-21 |
| Last Update Date | 2019-09-13 |