| NPI | 1881989234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 204E00000X Oral & Maxillofacial Surgery (Licence: MN 59378) |
| Additional Taxonomies | 122300000X Dentist (Licence: MN D13023) |
| 204E00000X Oral & Maxillofacial Surgery (Licence: MN D13023) | |
| Enumeration Date | 2011-06-14 |
| Last Update Date | 2020-08-13 |