| NPI | 1710958368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 29525) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: MN 29525) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2007-07-08 |