| NPI | 1710411525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: OK 236) |
| Additional Taxonomies | 208600000X Surgery (Licence: OK 40017) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2024-06-27 |