| NPI | 1679918288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: TX S9868) |
| Additional Taxonomies | 208600000X Surgery (Licence: TX S9868) |
| Enumeration Date | 2013-05-09 |
| Last Update Date | 2023-02-24 |