| NPI | 1710419353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AZ D011035) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D011035) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: CA 102128) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: CA 102128) | |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2024-05-01 |