| NPI | 1861002719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 2952000716) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: MI 5315214666) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MI 5315214665) | |
| Enumeration Date | 2020-08-05 |
| Last Update Date | 2026-06-12 |