| NPI | 1891756367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: ID D-4979-OS) |
| Additional Taxonomies | 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: WY 1545) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: NM 2698) | |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2021-02-09 |