| NPI | 1801025770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: LA 7519) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 23971) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: LA 7519) | |
| Enumeration Date | 2009-07-13 |
| Last Update Date | 2024-11-13 |