| NPI | 1831509645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 64379) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D13381) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: MN D13381) | |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN D13381) | |
| Enumeration Date | 2014-05-01 |
| Last Update Date | 2020-07-27 |