| NPI | 1760590509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AZ D05182) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: AZ D5182) |
| 208200000X Plastic Surgery (Licence: AZ 29085) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 18135) | |
| 208200000X Plastic Surgery (Licence: TX L0398) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2023-07-27 |