| NPI | 1740644178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: KS 62195) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 29512) |
| Enumeration Date | 2016-04-12 |
| Last Update Date | 2024-09-12 |