| NPI | 1821112723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MD 13683) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401411283) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0101238043) | |
| Enumeration Date | 2007-03-17 |
| Last Update Date | 2020-03-10 |