| NPI | 1801961859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: NV MD6631) |
| Additional Taxonomies | 174400000X Specialist (Licence: NV md6631) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2009-12-10 |