| NPI | 1700176625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 5887) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: AL 35969) |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2018-03-17 |