| NPI | 1811970700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: DE G10000865) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: PA DS021814L) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2007-07-08 |