| NPI | 1790852838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AR E-9509) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX H8161) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX 17576) | |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2016-04-11 |