| NPI | 1780887984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NV S2-21) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV S2-21) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: NV 2319) | |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2023-08-31 |