| NPI | 1801892047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: KY 37301) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: KY 37301) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2024-04-18 |