| NPI | 1851706048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: AZ 63279) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: AZ D010965) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2023-05-22 |