| NPI | 1699901868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MO 2009013156) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MO 2009013156) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: KS 60883) | |
| 2082S0099X Plastic Surgery, Plastic Surgery Within the Head and Neck (Licence: MO 2009013156) | |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2020-11-19 |