| NPI | 1831496843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: ID D-4845OS) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: ID M-13732) |
| Enumeration Date | 2011-02-28 |
| Last Update Date | 2018-04-16 |