| NPI | 1679940308 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 72001) |
| Additional Taxonomies | 1223P0700X Dentist, Prosthodontics (Licence: MN R638) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13962) | |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2022-08-12 |