| NPI | 1760917199 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 71444) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MN D13854) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MI 4301510733) | |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MI 2901601996) | |
| Enumeration Date | 2017-04-24 |
| Last Update Date | 2026-03-23 |