| NPI | 1720399017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NC 8934) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MA DL10927) |
| Enumeration Date | 2010-07-01 |
| Last Update Date | 2018-03-17 |