| NPI | 1760532139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN 11100) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: WI 5006) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN 40391) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2013-12-20 |