| NPI | 1740232263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: DE G30000446) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NY 044796) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: NY 2085951) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: DE C1-0011778) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2016-10-06 |