| NPI | 1811960388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: CO 10214) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: TX 21512) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CO 10214) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: TX 21512) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2024-04-08 |