| NPI | 1740709724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NE 7403) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NE 7403) |
| 261QS0112X Clinic/Center, Oral and Maxillofacial Surgery (Licence: NE 7403) | |
| Enumeration Date | 2017-09-12 |
| Last Update Date | 2017-09-12 |