| NPI | 1881911600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: VA 0438000349) |
| Additional Taxonomies | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: VA 0401414822) |
| 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: MA DN1856488) | |
| Enumeration Date | 2010-05-04 |
| Last Update Date | 2019-07-21 |