| NPI | 1831353747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: FL 18401) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MN D12636) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN 56616) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2014-09-02 |